Dec 12, 2015

AstraZeneca Seroquel - The Miller Firm LLC, Ennis and Ennis, P.A., Saiontz & Kirk, P.A."You Had a Lawyer" - blowing more ambulance chaser smoke without much substance - "selling a bad settlement for profit"

AstraZeneca Seroquel - The Miller Firm LLC, Ennis and Ennis, P.A., & Saiontz & Kirk, P.A."You Had a Lawyer" - blowing more ambulance chaser smoke without much substance - "selling a bad settlement for profit"

I have become aware of this little gem of an interview at Soulful Sepulcher Blog this morning that is just begging for a proper response and some thoughtful critical commentary. It appears Ennis & Ennis PA is another Saiontz & Kirk, P.A. that trolls for & gathers up cases, that they then sell off to other firms for a nice tidy profit. So instead attempting to respond in a long winded diatribe in this opening salvo; I will just add my commentary and a response to Mr. Ennis in RED font after each of Attorney David Ennis answers below.

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The AstraZeneca Seroquel diabetes litigation lawsuit: Interview with Attorney David Ennis

The AstraZeneca Seroquel diabetes litigation lawsuit: Interview with Attorney David Ennis
An interview with Attorney David Ennis from the law firm http://ennislaw.com/ Ennis & Ennis, P.A. a “plaintiff's national personal injury law firm concentrating on representing individuals who have been injured due to medication side effects, defective medical devices and defective products.
For the purpose of this interview I emailed Mr. Ennis questions, and I have copied them directly into this post. My questions are italicized.
Hi David, thanks for agreeing to answer some questions regarding the AstraZeneca Seroquel litigation. In the last several months news reports have announced a settlement in the Seroquel diabetes lawsuits. Plaintiffs were mailed information packets that they were to sign and mail back within a set time bracket. The Seroquel Lawsuit blog http://seroquellawsuitblog.blogspot.com/ has reported that the Miller Firm has not met the required percentage for the settlement offer, based on the numbers required by AstraZeneca. (This was stated on the Miller Firm’s recent information recorded update)With less than the 93% of the plaintiffs packets returned, this leaves many questions as to the future outcome of these cases.

1.Due to the deadline passing for the clients to return their settlement offer packets what are you and other law firms doing to move the lawsuit toward final settlement?

Ennis: I cannot speak for other law firms. Ennis&Ennis is assisting the Miller Firm in trying to locate clients we represent together who have moved from their last known address.

Commentary: I find it quite interesting, as well as more than a tad bit disturbing that now at this late juncture & over a year since The Miller Firm announced they had reached a settlement offer, (Dec. 2010). that both The Miller Firm and Ennis & Ennis PA are having such trouble tracking down these mysteriously missing clients only when it has become clear that the the settlement has not come anywhere close to meeting the 93% acceptance criteria agreed upon in the contractual stipulations of the AstraZeneca written settlement offer.  

In fact, it seems somewhat ludicrous that only now when this settlement is on the rocks, that these non-participating co-counsel case gathers and sellers are making any kind of effort to contact clients. Where were those efforts for the past few years?  In Fact, if you had made any kind of genuine effort to keep in contact with your clients or to keep them regularly informed, there would be no need for this last minute & far to late desperate missing client search happening only when it appears your ambulance chaser "Pay Day" is going down in flames.

2.Will AstraZeneca continue to negotiate and receive late packet agreements from clients who missed the deadline? Has the deadline been extended?

Ennis: We are working with AZ to meet the terms of the settlement agreement.

Commentary: A lawyer speak answer for "This settlement is dead" and we have no intention of renegotiation or going to trial on our clients behalf. We are just desperately hoping AstraZeneca throws us a bone; since we have worked so hard selling this horribly unfair & insulting settlement for them & just maybe we can salvage our glorious pay day. 
 
3.How many clients did you represent in the litigation, and how many returned and accepted the settlement offer?
Ennis: Ennis&Ennis represents 187 clients. 122 have signed and accepted the terms. 5 others are sending in their packets. Very few have opted out. We located 5 more this week who are signing and sending their packets back to our office. 

Commentary: So Ennis is saying they have roughly a 65% approval (Miller Firm stated in phone recordings that the over all approval was at around 60%, which makes a very large and astonishing 40% rejection of this settlement offer) especially when it's  clear that it takes a 93% approval to make this settlement to fly that by their own admission the plaintiff firms state will not be met. 
I hope everyone takes heed that Ennis will not even mention the numbers of those clients that have "REJECTED" the settlement outright! That is no simple mistake or omission unfortunately; because the Ennis firm has a rough estimate $350,000 pay day at stake...Client's be damned right...this is about seedy law firms selling a bad settlement to get their pay off money and move on to the next tort backroom deal...
 
4.Did you have clients appeal the settlement offer? Did clients have an opportunity to reject the offer?
Ennis: Clients had an opportunity to reject the settlement offer.

Commentary: OH REALLY! So even though the original offer paper work stated that clients would be given an opportunity to reject the settlement; there was never a single box to check or form to sign that would have given a injured party a clear choice to either accept or reject the settlement being offered to them.
Mr. Ennis is being disingenuous at best here..we know that the only way a client could realistically reject this offer was to not sign on to the process, or not to return the original paper work. And now they are trying to sell "The Missing Ghost Client & Packet " theory!!
Next thing we'll see; is Ennis and co-counsel will be actually starting to believe their own nonsensical advertising & corny promotion commercials...maybe they need an intervention & anti-psychotic medication? I'm quite sure their pals at AstraZeneca can help them out in negotiations on that front....


5.Does the lack of percentage of clients returning the packets indicate the client discontent with what was offered to them for a settlement in monetary terms?

Ennis: In a settlement neither party is happy with the terms. Every litigation is different. The defendant always feels they should not pay at all and the plaintiff always feel the settlement amount is too little. There is a risk for both sides. The lack of percentage of clients not returning packets has been the result of plaintiffs not being at their last known address.  

Commentary: I really need to get an industrial fan to clear all that smoke being blown here by Ennis: Neither party happy? I'm sure Ennis is fully aware that The Miller Firm (his co-counsel) has presented a settlement offer to their client's that has not only been called "very low considering similar prior settlements with like effect drugs" by many expert observers, but is also a mere faction of what other firms offered their clients with similar injuries in this very same litigation.

 Again, if Ennis or Miller had actually kept in contact & had any reasonable relationships developed with their clients while keeping them informed throughout this process; they would have no problem with this so called missing address and ghost client debacle. These facts clearly lead us to conclude that Ennis & co-counsel Miller could have cared less about injured parties concerns or questions until it was time to sign off on their "The Laws Firms" pay day. 
 In fact, if these ambulance chasers (being kind) had taken even the most elementary efforts at vetting or investigating the injured parties claims and cases; this would not be a problem...but when you use injured clients simple as cash cows for secret backroom quick pay day settlements...what do you expect to happen...same old song & dance...but your clients & I aren't buying it...either should the public...

If you haven't noticed a theme that permeates here, Ennis or co-counsel doesn't talk much about having compassion, empathy, or even attempting to try on those damaged shoes of the client's they are supposed to represent...the problem is that "they" (the lawyers) are focused only on receiving their own bounty money: Yet, truly respected attorney's believe in their clients, believe in the cases they accept, and they are willing to take the calculated risk of making the treasured investment of time, professional expertize, financial commitment, & with zealous ethically grounded steadfastness represent their client in seeking a just and right outcome/resolution/verdict in a court of law before a jury...

6.How long will you continue to search for clients that may have changed addresses? On that note, weren’t the packets mailed via certified mail for a record of receipt? Therefore could lack of returns represent a client not wanting to participate in the settlement?

Ennis: There is no set time limit. Our office personally called 65 clients this week and unfortunately were only able to locate 6. Many phones are out of service or have been disconnected. The Miller firm has hired outside companies who specialize in this to try to locate these clients.

Commentary: No set time limit? I call out BULLSHIT!!! This was certainly not the case when Garretson Resolution Group and The Miller Firm gave injured clients a strict time limit (1 week) to return the offer packets or to appeal the offer ( refer to page 2 & 6 of the Miller/Garretson offer) ...So I gather what your saying...the only time rules happen to apply in this litigation are when you (the Lawyers) decide to create them for your own convenience...

I find it quite insulting that your attempting to make excuses for a clear rejection of this poor & unjust settlement. I think it would have been really nice if The Miller Firm had actually invested a fraction of the time and energy they are putting forth trying to sell this settlement; into actual putting together a single formidable case to go to trial. Yet, we know now, that was never going to be the case. 

Law Firms like Miller and Ennis let other firms do the hard dirty work of trials and evidence collection; they pass up on that arduous work, and go directly past "GO", while collecting hefty piles of blood soaked client monopoly money.

7.Some readers, as well as myself have opined that the settlement was “low-ball”, for a life time body damage of diabetes as a result of taking Seroquel. Do you feel the settlement terms were fair to the injured clients? 
Ennis: Again if you speak to most Plaintiff lawyers they are never happy with the settlement amount and if you speak to most Defense lawyers they feel they have paid too much. If you assume Seroquel was 100% responsible for someone's diabetes then one can argue no the settlement amount was low. But the evidence did not support that 100% was related to Seroquel. Both sides had qualified experts, but unfortunately the Florida Judge ruled 4 times against Seroquel plaintiff's and the Delaware judge ruled 3 times against Seroquel plaintiff's. Those 7 plaintiff's received no compensation. The parties were ordered to mediation which is very common and settlement agreements were reached. 

Commentary: Is Ennis actually going to sit there playing apologist for AstraZeneca? 

Evidence! You've got to be F-ing kidding! Quite obviously "the qualified experts" & "evidence" Ennis & co-counsel have not gathered to the point of these bad settlement offers didn't quite cut the mustard..

That's when true professionals and ethical counsel take the time to re-evaluate their strategy, come back with more convincing evidence, better & accepted experts, and keep bringing strong cases forward...this whole lose 1 of out of 30,000 or more and just lay down & quit routine being uttered is beyond absurd...it doesn't pass any smell test...and it's morally & ethically reprehensible..
Ennis..you did happen to realize going into this litigation that it wasn't going to be easy...AstraZeneca decided to draw the line in the sand, play some serious legal hard ball, & spent upwards of a billion dollars to date in buying the best "experts", "legal counsel", and "who knows what else"  on the planet. In fact, this blog is chalked full of convincing evidence & much more has been compiled since this seedy backroom settlement deal has been conspired. 

No one with an ounce of common sense thought or would have imagined that plaintiff's would win each and every case. But, there are 30,000 plus cases (and more waiting in the wings) that could & should have been considered for and taken to jury presentation. 

Just because parties are ordered by the court into a mediation process does not means that plaintiff attorney's are supposed to capitulate and accept settlements that add up to nothing more or less than the cost of continuing to litigate..this settlement has never been about injured parties...or the evidence...it's been about clearing the slate and profiteering off of those Ennis (and supposed co-counsel) have taken a solemn oath to serve in the client's best interest. 

These kinds of glossed over answers and lawyer speak propaganda statements are just smoke blowing sessions that serve to further validate what this blog has been saying for some time now. 

No one, including their supposed legal counsel has stood up for the injured parties best interest in this litigation. These kinds of poorly negotiated settlements by attorney's that win financially by losing: just continue to highlight the importance of getting cases before a jury of ours peers. Justice is  absolutely being grossly subverted or forever corrupted here, and sadly by the very people sworn to serve this time honored promise & principle of our Republic.



8.Were all of the clients with all law firms involved offered the same amount of monetary settlement? If not, this does not seem fair; can you explain why for example, one law firm can offer a higher amount for settlement than another to their clients?

Ennis: The settlement negotiations are confidential. I am not aware nor would we be privy to what other firms settled their clients claims for. What I can say is that AZ felt they should not have to pay anything since they had won 7 cases and had many more cases dismissed and the plaintiffs were not happy because they felt the compensation was not enough. When both sides are unhappy that is the definition of a settlement. Nobody wins in a settlement. The only time you have a clear cut win or lose is if a jury decides the case. As of the date of the settlement the Judges hearing these cases had dismissed all of the cases before them. 

Commentary: actually not so confidential after all correct! Ennis & Ennis has been to this blog in the past...I find it highly suspect that they would have not read the other settlement packets here...or that they are completely unaware of what other firms settlement offer averages are (for your education: Miller Letter and settlement offer differences)...Obviously no one except the lawyers (Ennis, Co-counsel, AstraZeneca) are winning in this settlement...certainly not the injured parties....In fact, how many cases do you think Ennis & co-counsel have actually brought to trial in this litigation...The Answer is ZERO...Of course Miller & Ennis; you can't win at trial, unless you actually take a case to trial...


9.Do the attorneys representing the Seroquel victims get paid even though the required percentage was not met? If the required percentage of 93% is never met, will the attorneys be paid anything, or will they require payment from their clients?

Ennis: We have not received any attorneys fees or reimbursement for costs. The lawyers do not get paid until the clients get paid. The clients who wish to opt out will not be responsible for attorneys fees or costs unless they agree to the settlement.

Commentary: Did Ennis wear his dancing slippers while answering this one....
this is what is most likely going to happen:

The Miller Firm only has four options..

1. renegotiate the settlement ( they have stated on numerous occasions they will not do this)
2. take cases to trial ( again, they have stated vehemently on numerous occasions they are not going to take a single case to trial)
3. continue to sell the failed settlement as is (this would mean them somehow magically meeting the 93% approval threshold or AstraZeneca simply walks away)
4. walk away from the Seroquel litigation ( this means they will have no other recourse than drop all of their clients. which means The Millers Firm & co-counsel "other firms that sold their cases to The Miller Firm like Ennis&Ennis; will receive nothing, and will eat the cost invested thus far in this litigation **which appears to have been quite minimal by the way**)

Hope that clears some of the smoke being blown here! I certainly hope it's just not me seeing this dead whale being washed up on the beach...


10.I have noticed many of the drug injury law firm websites no longer host information on Seroquel, or Seroquel litigation updates. Was that part of the agreement required of law firms by AstraZeneca?
Ennis: No. 

Commentary: out of sight, out of mind......these firms are busy selling other drug & device litigation...they certainly don't want their "Seroquel" dirty laundry being exposed out in public for all to see....that's not good PR for the legal case gathering and sell off business, especially don't want those next sucker potential clients to see how the dirty game is being played....

11.Have attorneys been threatened, or felt intimidated by the AstraZeneca legal teams?
Ennis: No

Commentary: LMAO  , How about injured clients being threatened & intimidated by the plaintiff attorney's? Expected answer: No Comment, cat has got their tongue...

12.What happens next with your and Miller Firm clients? (How are you associated with the Miller Firm, if at all?)Will any law firms be taking individual cases to court after the time is up and the 93% has not been met? Will you be representing clients individually in court if the 93% is not met?
Will you be representing clients individually in court if the 93% is not met? 

Ennis: We are co-counseling our Seroquel cases with the Miller firm. Both firms have extensive experience in Mass Torts. As previously explained we are attempting to locate clients to communicate the settlement terms. 

Commentary: Ennis can't seem to get off his tap dancing sell the settlement band wagon here...what Ennis avoids telling us is that The Miller Firm has made it very clear on numerous occasions that they are not going to take a single case to trial going forward...so they are either lying...or clients will be dumped to the curb in mass...unless Ennis is stating that his firm will be taking Seroquel cases to trial? Is that what your saying Mr. Ennis? 
I'll be awaiting your response with breathless & bated anticipation!

13.How many clients in the 26,000+ cases appealed or rejected the Seroquel settlement offer?

Ennis: I do not know the answer to this question. I can only speak to the clients who retained our law firm as co-counsel with the Miller firm.

Commentary: But you haven't said or mentioned how many of the Ennis or Miller Firm clients have REJECTED the settlement offer (40%)...in fact, all you will talk about is tracking down these mysterious missing packets and ghost clients....SMOKE! Anyone?

14.In the next 30-90 days what do you think the news will be regarding the lack of 93% required packets? How long will AstraZeneca be willing to wait for law firms to gather missing client packets? Have you or have other law firms pressured clients to take the offer? 

Ennis: I do not have a crystal ball. I can only say based on the clients we have located I expect the response to be similar to what we have already reported. If 93% are not reached then AZ will have to make a determination do they want to pay the clients who have accepted the terms of do they want to go back to court to defend the claims and incur additional defense costs. We are not at that stage at this point. No one is at fault here it is just a matter of locating the clients. As previously discussed this is a very transient population. I think in the next 90 days a lot of these issues will be cleared up. It is not is anyone' s best interests to be adversarial toward one another. The parties are working to resolve the issues.

Commentary:  The legal process by definition is an adversarial process; I find it unbelievable that an attorney of all people (using the term "people" loosely) would be lecturing anyone on process civility; especially in light of how badly clients have been treated, mislead, and left completely in the dark by The Miller Firm. 

Ennis states he doesn't expect the 93% threshold to be met even after concluding their suspicious ghost client hunt correct. On the Miller firm update recording this past week it stated that AstraZeneca is not releasing funds because the conditions of the agreement have not been met...

I would like you to clarify your position for everyone please....Is The Ennis & Ennis firm going to move forward representing their clients against AstraZeneca in court within the next 90 days if this settlement is not approved...? 

I'm sorry, but this shocking news, a giant unexpected revelation, & information that appears to fly in the face of everything your co-counsel (The Miller Firm) has been telling their clients...Talk about a confusing and baffling smoke-N-mirrors quandary...


15.What words of advice do you have for people injured by pharmaceuticals in the future? Will it be even more difficult to go up against “Big Pharma”? 

Ennis: People who have been injured by Big Pharma should not be discouraged by this outcome. We still live in a country where people who have been wronged have a right to hold the responsible party accountable. The problem is if you give away those rights you will be left with nothing. Big Pharma and other corporations always try to discourage litigation because it is in their best interest. Remember if the victim does nothing you get nothing and Big Pharma wins. As long as lawyers are willing to take the risk and we can get access to a jury we can equal the playing field. Over the last decade it has become more difficult due to political influences. We need major reform in this country against Medical Device manufacturers and generic drug makers. In the last 3 years patients have lost 2 major Supreme Court Decisions. One decision gave Medical Device manufacturers preemption for 360 device approvals. This must be changed in the legislature. Further this past summer the Supreme Court ruled Generic Drug Manufacturers Preemption if you took a Generic Drug. So if your neighbor took the Brand Drug and was injured he has a right to compensation, but if you took the same drug from a Generic Manufacturer you are barred from bringing a claim. This is a total injustice. Your readers need to call their Congressman and demand the Legislative Branch to overturn these terrible decisions. I recommend all of your readers to view the HBO documentary titled, "Hot Coffee" to really get a true understanding of what we are fighting against on a daily basis. It is a good fight and we will keep representing the victims unless our Political System shuts the door to the Court House's around our country. I hope this shed's some light to your readers on these issues. -David Ennis, Attorney


Commentary: Funny you would mention the "HOT COFFEE" documentary...that case actually went to trial...I don't see how firm's like Ennis & Ennis stock piling drug injury cases, and then selling them off to firms like Miller serves justice or clients. I certainly don't see how turning individual injury "TORT" claims/litigation into some kind of very profitable (for the lawyers) bastardized Class action system is serving injured parties or justice. 

Though, I do encourage concerned parties to call or contact their congressman, department of justice, attorney bar associations in regards to holding plaintiff attorney firms accountable to their professional & ethical obligations, and to also open the courts once again to the constitutional promise of having our just day in court before a jury of our peers.

I guess that concludes this interesting question and answer session; really not much in the way of clear answers from Ennis...but you can't really judge someone to harshly for blowing a little smoke our way now & then...

The Seven Year Itch: Seroquel used as a sleep aid in 2004, continues 7 yrs later

           Photo credit Jeff Gentner  /  AP
Shirley and Stan White's son, Andrew White, died in his sleep on Feb. 12, 2008, while taking a Seroquel, a powerful antipsychotic prescribed as a sleep aid. Shirley White holds a box of her son's prescription medication is photo taken in the their son's bedroom in Cross Lanes, W. Va.

Antipsychotic Prescribed as Sleeping Pill by Matthew Herper, Forbes September 2004

"When AstraZeneca introduced the schizophrenia drug Seroquel in 1997, it was a dud. The London-based drug giant had no experience selling psychiatric drugs, and its then small sales force couldn't compete with the might of Eli Lilly and Johnson & Johnson, which ruled the market for antipsychotic medicines."

AND

"Henry Nasrallah, a psychiatrist who is the associate dean of the University of Cincinnati School of Medicine, says he has prescribed Seroquel as a sleep aid for patients who also suffer from other mental disorders. "A lot of our patients beg us for sleep," says Nasrallah. "And if we are going to give them something for sleep, we want to give them a mild, not harmful, drug that seems to help both their sleep and their depression or anxiety."

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Since the writing of Herper's 2004 article, Seroquel grew into a blockbuster antipsychotic that continues to be prescribed off-label for insomnia. The drug is connected to veterans dying in their sleep. Often prescribed to vets for insomnia and PTSD, the antipsychotic gained momentum the last 7 years, with increased sales and prescriptions.

The doctor quoted in the 2004 article above, psychiatrist Henry Nasrallah, is a doctor whose hand is heavily in the pharmaceutical paid speaker cookie jar. Nasrallah receives income from AstraZeneca, Pfizer and Johnson and Johnson, which could be a conflict of interest, when speaking about Benedryl vs. Seroquel as he did back in 2004.

It's incredible this story can be written again today, 7 years later. Since then AstraZeneca was fined $520 million dollars for illegal marketing of Seroquel, entered a CIA (Corporate Integrity Agreement) with the Dept of Justice, and internal documents have been exposed detailing AstraZeneca insiders as knowing the antipsychotic had metabolic possibilities, with weight gain and diabetes.

Seroquel lawsuits totalled 26,000 and some remain to be heard in court while others have an unsettled case, where the plaintiffs are waiting for actual settlement numbers, and even information packets. Bloomberg reported cases settled in August 2010 and those plaintiffs have yet to see a dime of settlement money, though the general consensus is about $10,000 per person, for a lifetime body damage of diabetes.

The drug is in multiple trials in the XR version for a multitude of indications.

There are some people who tout atypicals as wonder drugs, and some might say they "work". For those who say that, I say listen to those who this drug in particular has injured. Those are the ones paving the way to AstraZeneca's Golden Wonder Drug blockbuster bank account, the drug that has become the multi-purpose antipsychotic and the one with dangerous side effects....yet where are the funtioning Schizophrenics or patients who suffer with psychosis? what are they saying about this drug's usefulness?

When does America stop tolerating paid pharma doctors and researchers? What will the next 7 years bring? how many more lawsuits or deaths?

Dec 11, 2015

AstraZeneca Sues the FDA to extend Seroquel patent & profits - The outrageous hypocrisy of it all


AstraZeneca  Sues the FDA to extend Seroquel patent & profits - The outrageous hypocrisy of it all

Yes, it's beyond ludicrous I know....but those very same greed mongering corporate thugs @ AstraZeneca who have stolen literally mountains of money by their blatant acts of illegal marketing, political pandering & deceit, and by hiding the dangerous & deadly side effects of the drug Seroquel while making it a multi-billion dollar a year block buster; are now suing the FDA because the soon to be released generic version of Seroquel doesn't have the exact same label warning incert as the AstraZeneca patented version. 

Now, very few rational people are going to argue that full, safe, and complete product labeling isn't a good thing. But let's get real here....AstraZeneca has never been concerned about safety or patient health when it comes to Seroquel...they sure as hell didn't want consumers (or anyone else for that matter) knowing all the dirty secrets and dangerous details of this drug when marketing Seroquel into a mega billion dollar per year profit maker. Now they want to hold on to their deadly cash cow patent even longer...please give us all a break...this is yet another case of the special & privileged corporate elite abusing the legal system, the citizens of America, & others from around the world purely for greed's sake.

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AZ's Seroquel Battle with FDA: A Mark of Desperation?

By Ana Nicholls, Healthcare Analyst at the Economist Intelligence Unit.

Is it a mark of desperation? UK-based pharma company AstraZeneca has resorted to suing the US Food and Drug Administration in a bid to stop it from approving generic competition to Seroquel, the company’s blockbuster anti-depressant, before December 2012. The core patent for Seroquel IR expired in September last year, and its paediatric patent runs out this month, although Seroquel XR (the later version) still has protection till 2017.


The FDA has yet to approve a generic version, and AstraZeneca is arguing that it should not do so. The company claims that important decisions have still not been made over warning labels on the generic versions of Seroquel IR, which need to mimic those on the original, while it still has data exclusivity rights stemming from the clinical trials it has conducted.


AstraZeneca tried a Citizens’ Petition against the FDA earlier this month, with no joy, so it is now trying a lawsuit. The case is a long shot, but the costs will certainly be far lower than the losses the company will incur when Seroquel’s patent expires. The drug generated sales of US$4.3bn worldwide last year, of which US$3.3bn was in the US. Moreover, if AstraZeneca wins, then it (and other companies) may also have developed another way of extending protection for many of the drugs that are coming off-patent.


If so, that would be very welcome news in this, the steepest year of the patent cliff. This year, around US$27bn-worth of blockbuster sales will be exposed to generic competition in the US, according to Fitch Ratings. AZ, along with Pfizer and Forest Laboratories of the US, is one of the companies hardest hit. AZ calculates that it lost almost US$2bn in revenue during 2011 as a result of generic competition. Other companies have tried different tactics to protect their patents – Pfizer, for example, struck exclusivity deals with pharmacy benefits managers to protect sales of Lipitor after its US patent expired late last year.

Yet the mood in the US is firmly against pharma companies who are seen as blocking competition, making the likelihood of AZ winning its case appear remote. Though attempts to legislate have foundered, the current US government has campaigned against what it dubs “pay-for-delay” tactics, which mainly involve deals between pharma companies and their potential generic competitors. The chairman of the Federal Trade Council Jon Leibowitz claimed last year that such arrangements cost consumer US$3.5bn a year in higher drug prices.

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Once again in this article above, Seroquel is being referred to as an antidepressant drug - so let's make it absolutely clear, and correct once again this often used blatant mistake reported by the main stream media & others.

Seroquel is not an antidepressant drug...it is a powerful neuroleptic drug (anti-psychotic).

neuroleptic drug - tranquilizer used to treat psychotic conditions when a calming effect is desired

Placing an IOL in the Sulcus

An intraocular lens (IOL) can be placed using remnants of a damaged capsule. The 4 most common situations (probably in order of occurrence): anterior capsular tear without extension, posterior capsular tear with intact anterior capsule, anterior capsular tear extending to a posterior capsular tear, and zonular dehiscence.

Technique   The most important part of placing an IOL in the sulcus is getting both haptics in the sulcus. The most common problem cause of decentration is to have one haptic in the sulcus and the other in the bag. One reason that it is hard to get both haptics in the sulcus is that the most common area of damage to the capsule is directly across from the wound. This area is vulnerable to radial tears as ophthalmic viscosurgical devices (OVD) are often running low as the capsulorrhexis passes this point, and this area is vulnerable as the phaco tip and chopper are active in this region. Unfortunately, this same area is where the leading haptic naturally flows during IOL insertion. If the capsule is damaged in this area, then the sulcus is poorly defined and the leading haptic can end up posterior to the anterior capsule rather than in the sulcus as intended.

When I am faced with capsule damage across from my wound, I will often inject the IOL into the eye and direct the leading haptic anterior to the iris in the anterior chamber to avoid the damaged capsule. I then will use Kelman McPherson forceps to place the trailing haptic into the sulcus. I then use an instrument like a Sinskey hook to rotate the IOL about 90 degrees so that the haptics are away from the damaged area. Then I take the Sinskey hook through a paracentesis, slide it over and hook onto the leading haptic, and pull the haptic inside the pupil and release the haptic just under the iris into the sulcus. Defining the sulcus with a viscous dispersive viscoelastic (eg, Viscoat) will greatly ease placement of the haptics.  If the anterior capsular tear is intact, round, and centered then prolapse the optic posterior into the bag.



Sulcus IOL Selection    Another very important issue for suclus IOL placement is the type of IOL. The perfect IOL for the sulcus has a large optic that is forgiving of mild decentration and permits a better view of the peripheral retina; has long haptics with an overall length that will center the IOL even in large eyes (eg 13.5 mm); and has smooth, thin haptics to reduce chaffing of the posterior leaf of the iris [1]. Thick haptics such as those of the popular single piece acylic IOLs (eg. SNWF, SA60, technic) can rub on the posterior leaf of the iris leading to iris transillumination defects, inflammtion, hemmorrhage, or pigmentary glaucoma. I prefer acrylic to silicone IOLs for sulcus implantation because patients with capsule trauma are at increased risk for retinal detachment and the possible use of silicone oil. I like the Alcon MA50 3-piece IOL (Fort Worth, Tex) because it has wide haptics, a large yet injectable 6.5-mm optic, unfolds slowly, and it is acrylic; however it has a square anterior edge and only 13.0 mm haptic length (may not be enough for longer eyes) [2]. Other prefer the Starr AQ1020V as it has a large optic, smooth anterior surface, and long 13.5 mm hatpic length; however, it does have a silicon optic and can unfold fast [1].

Please remember that some IOLs are larger than the 6.25 mm Malyugin ring used for small pupil expansion.  place the IOL optic below the malyugin ring before it uncurls completely to allow the optic to get behind the Malyugin ring  (see video).

 

As an IOL in the sulcus is more anterior than an IOL in the bag, the power of the IOL must be reduced. In Omphroy's study of 30 sulcus-based IOLs, we found that the A-constant should be lowered by about 0.8 diopters [3]. Other studies have had similar results, suggesting that we decrease the power of sulcus-based IOLs by 0.5 D to 1.0 diopters.    The shorter the AEL the bigger the adjustment that is required.  Please see Dr Warren Hills great web site on this topic: http://doctor-hill.com/iol-main/bag-sulcus.htm

It is very important to eliminate any vitreous in the area of IOL insertion. Vitreous streaming to the wound or to a paracentesis can cause IOL decentration. Careful bimanual anterior vitrectomy aided with Kenalog (Bristol-Myers Squibb, New York, NY) (not approved by the Food and Drug Administration for this indication) will greatly assist in the long-term stability of the IOL and retina.

There is no need to place a peripheral iridotomy when placing an IOL in the sulcus.

Indications for Sulcus based IOL   When the anterior capsule has a tear but the posterior capsule remains intact, one can often place an IOL in the bag. IOL insertion should be gentle, placing as little stress on the bag as possible. I prefer a single-piece acrylic in this case because the soft acrylic haptics, oriented 90 degrees away from the tear, create little tension on the bag, minimizing the risk of extension of the tear. My experience is that the single-piece acrylic is stable in the bag with a radial tear and remains centered. The disadvantage to placing this IOL in the bag with an anterior capsular tear is that should the radial tear advance to the posterior capsule during insertion, this IOL must be removed and exchanged for a 3-piece IOL suitable for the sulcus.

When the posterior capsule is torn and the anterior capsulotomy is intact, you have 2 options for the sulcus and one for the bag. One sulcus option is to simply place the IOL in the sulcus. The second, which I often use, is to place the haptics in the sulcus as described but then use a Kuglen hook to gently prolapse the optic back into capture by a well-centered anterior capsulotomy. This optic capture is very stable and seals off the vitreous from the anterior chamber.

The final option applies to stable posterior capsule tears such as round holes from a direct phaco needle strike or those tears completed with a posterior capsulorrhexis, and that is to gently place a single-piece acrylic IOL into the bag.

When the posterior and anterior capsules are both torn, it is best to seal off the area with Viscoat and to place the 3 piece IOL in the sulcus as described above.  If the IOL does not seem secure then use iris sutures to secure the haptics to the iris. 

When the zonules are weak try placing a capsular tension ring (CTR) with or without a suture. If the area of zonular loss is less than 3 clock hours, I would place a conventional CTR. If for some reason a CTR was not available, the IOL will usually remains in position in the sulcus with 3 clock hours or less of zonular dialysis especially if a 3 piece IOL is placed with the haptics in the area of the weak zonules.  If the area of zonular loss is greater than 3 clock hours, I would use an Ahmed segment sutured to the sclera or suture the eyelet of a modified CTR (Cionni). If not available, I would be very cautious placing the IOL into the sulcus with this amount of zonular loss. I would try to place the IOL in the sulcus but have a very low threshold for iris suture fixation. Another option is to use Agarwal's technique to glue the haptic into a scleral tunnel [4].

Summary  Capsule damage and zonular weakness are common in our surgical practice.  We must have sulcus IOLs ready and be prepared for their insertion.   It is important to be ready for this rare but

References

1. Chang DF et al . Complications of sulcus placement of single-piece acrylic intraocular lenses: recommendations for backup IOL implantation following posterior capsule rupture. J Cataract Refract Surg. 2009 Aug;35(8):1445-58.
2. Chang DF, Curbside Consultation in Cataract Surgery: 49 Clinical Questions, Chapter 33: When and How Should I Implant an Intraocular Lens in the Ciliary Sulcus?, Slack, NJ, 2007
3.  Maassen, J, Oetting T, Omphroy L. A constant for sulcus based MA60BM. Unpublished data presented at: University of Iowa Ophthalmology Resident Research Conference; Iowa City Iowa, May 19 2006. link
4. Kumar DA, Agarwal A, Prakash G, Jacob S, Saravanan Y, Agarwal A. Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes. Eye (Lond). 2010 Jul;24(7):1143-8.

THE CLIENT DUMP - AstraZeneca Seroquel - The Miller Firm LLC

Micheal J. Miller - Chief Liar @ The Miller Firm LLC

Saiontz & Kirk, PA -  Non-Participant Co-counsel & Tort Legal Mill case gatherers & sellers
THE CLIENT DUMP - AstraZeneca Seroquel - The Miller Firm LLC - Saiontz & Kirk, PA "YouHaveALawyer", Ennis&Ennis PA - Pharmaceutical Tort Mills, Sleazy Liars, & Greedy Scoundrels

Well, we all knew this was coming....we just didn't know exactly how The Miller Firm LLC was going to try justifying their constant lies and magical settlement approval % manipulation. Today I received a copy of this letter below along with some enlightening correspondence from a long time trusted source.

My source stated that this "DUMP" letter is packed with misrepresentation & outright lies that have been conjured up by The Miller Firm LLC to avoid the appearance and undeniable reality that they have or are in the active process of a targeted and purposeful client dump in an unethical scheme to force a rejected settlement through solely for self gain.

My source went on to pin point inaccuracies in this DUMP letter starting with deceiving legal speak in the opening sentence stating:


 My "source" unequivocally states that Saiontz & Kirk P.A. was not hired to investigate a claim, but to represent the "source" in a valid, evidenced, and documented case against AstraZeneca.

The "source" stated that they did not hire The Miller Firm LLC to represent them in any way, shape, or form. In fact, Saiontz & Kirk P.A. sold the "sources" case to The Miller Firm LLC, while having no active involvement or participation as Co-counsel in the Seroquel Litigation from that time on. In fact all client questions & inquires were automatically forwarded to The Miller Firm LLC without their response once the sale had occurred.

Now, onto the most important point and evidential lie in this "DUMP" letter. My source stated that they "NEVER" "EVER" requested that their case be closed. In fact they sent in a valid appeal letter outlining their concerns within the 7 day time limit constraints The Miller Firm LLC & the Garretson Resolution Group placed on appeals, and for signing onto or not signing onto the settlement process.

 That appeal  letter was completely ignored by The Miller Firm LLC. In fact on numerous occasions in direct correspondence with The Miller Firm LLC; The Miller Firm Representatives stated that they were not going to take a single case to court, none were worthy of trial, and there would be absolutely no renegotiation of the settlement terms with AstraZeneca.

The Miller Firm LLC is acting today & as were they then; they are the sole cause or catalyst behind any and all separation of legal representation. For The Miller Firm LLC to even imply that the "Source" requested that their case be closed constitutes a totally fraudulent statement and most egregious blatant lie.

Who shall you the reader believe? Let's just match & compare the signatures on the "DUMP" letter below, to the THREAT letter Mr. Miller denied he wrote to Reuters News and Insight. In fact Miller & his firm, (including co-counsel) all appear to have some serious problems related to telling the truth and subsequent honesty.

So why might you think a request for being relieved of contractual obligation or being DUMPED directly by the Miller Firm LLC makes such a huge difference in this settlement going forward?

  Because The Miller Firm appears to using this misinformation/lies to drop clients from equations which directly skews the settlement acceptance percentages for this pay out proposal.

So instead of having a 40% rejection rate or 249 client rejections. The Miller Firm appears to have jettisoned most of those clients, and then went about the nasty business of recalculating the approval percentage numbers with the approximately 374 remaining approval clients to reach that magical 93% approval threshold to submit to AstraZeneca to cash in on their pay day.

The only problem here is that the clients didn't ask for their cases to be closed...they simply wanted to be properly represented or sent a notice of being released because they rejected the settlement by their original counsel. The Miller Firm is playing unethical slight of hand here...and are clearly attempting to erase the voices & rights of those injured parties that rejected this insulting settlement by closing their cases and then acting like they never existed to the calculations, the courts and to AstraZeneca... That is about as sleazy, disingenuous, and underhanded as it gets folks...

This is the 7.4 million dollar question that must be answered? Has The Miller Firm LLC & Co-counsel conspired against one segment of clients they have a sworn legal & ethical obligation too represent; to unequally represent another segment of clients they represent, solely for their own self gain & personal business interest?

This is the heart felt message I am sending out to the DOJ "Department Of Justice" & Federal Courts; are you listening to the actual injured parties and clients yet.....please do!